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Home My WebLink About0186 MITCHELL'S WAY - Health (2) �� Z, 2`�C) i 1` 0 ........................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... 0F.............� ''0,9fG ........--................ . WO�Npplirafivn for Bi-soposal Workg Tonstrurtion Vamit �A6 t�)�' Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at // ! S ...... T .....74 `"...... �.r� ..... ....................�'`�.....'�.........-----............................................. Location Address or Lot No. .......... ./ ...Y.........s .&./z/!........................ .........,,t .fi'�.Z�.S.�"�� Z ,...................................... ,9wner >� _ Address .......... � W .---.................. Installer Address QU Type of Building Size Lot...rd.L:..�1..........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'L Other—Type of Building No. of persons............................ Showers a g -------•---•---------------- --------.P._.__. ( ) — Cafeteria ( ) Other fixtures SS -------- W Design Flow................. ............gallons per person per day. Total daily flow..____........ 'd_�................gallons. WSeptic Tank—Liquid capaci }2OD.....gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No................. .. Width.................... Total Length.................... Total leaching area....................sq. ft. 5Seepage Pit No... ................... Depth below inlet.................... Total leaching area....�,o.. -sq• ft. Z Other Distribution box ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... a Test. Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__-_______________-_-_. f, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---• --•--•-----------•--•-.................-.................................•-••---------------.......................................................... 0 Description of Soil................................................. ------------------•---- -•--------- •--...-•--x . ------------------------------------------------------------------------------•-•-•.........----.......--••--------------------...--------------------................................................ U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ... ........-•----•-------------------•................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article X.I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h lth. Si`ned__-.. f _ Q � -------------------- ---------------�--' ` Date Application Approved By--=........-•- •..... ......... ....1-_ �ll�'-7_ ate Application Disapproved for the following reasons:_..____________________________________________________.__._.......---...................D .............. ....---•--------------------------•..--•-----------•---•-----..........------....-•--------•------------............................................................................................... Date Permit No. .... Issued --- �. ................ Date No..._'; .3------------ ._ ' Ficim.... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... �It.4'i.44I'�t, . ...-.__OF.............fucf..`!'�r•+'F'*^.'..a.,•'��1^�t��,'...".......- , App ira iaw.for 13hiposal Marks Tout drur$ion Vatnit Application is hereby made for a Permit to Construct (,. , ) .or Repair.. ( ) an Individual Sewage Disposal System at: y� ! / ,. ......_.uc.d_Z__._._____ ........ __ ___- ___________________..... ______________ ____ ______ ___...................................................... Location Address or Lot No ...........`...�f" y .._......T.}• f.7. �............................... r ....... _------. --- ---------•- owners �,s Ad ress a ................ ..................................................... d Installer Address Type of Building ,4 Size Lot... .......Sq. feet Dwelling,—No. of Bedrooms..........................................................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........_--------_.......... No. of persons............................ Showers ( ) — Cafeteria ( ) 0. Other fixtures .................................................... . W Design Flow................. .. kr_.____..._.....-:gallons per person per day. Total daily flow................... ..........gallons. 1:4 Septic Tank—Liquid capacity___*__....gallons Length................. Width......__.__•.... Diameter................ Depth................ xDisposal Trench—No_ ................ .. Width.....................Total Length..................... Total leaching area....................sq. ft. Seepage Pit No. ! ' r ZDiame ef........ Depth below inlet.................... Total leaching area___ e,,;.�sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation. Test Results Performed by__________________________________________________________________________ Date........................................ Test Pit No. L_______________minutes per inch Depth of Test Pit.................... Depth to ground water_-_____-__._.________ 44 Test Pit No. 2................minutes per.inch Depth of Test Pit.................... Depth to ground water------------------------ . --•--•----•--••----------•--•-•.............•-•--•-••---._....___.._..__.--------•---•--------•------•--................................................... 0 Description of Soil......................................................................---••-.............................................................................................. x Ir � ' IP � 'z". = _ x -------------------• --------------•-••--•--------------•-••-_____----•-••-------------------•---------..__..___..._..._.......................... •----•••----------•----................................................... 0 Nature,of Repairs or Alterations—Answer when applicable................................................................................................ -------••••-----------------•••-••-••-•-•..._...---•------••_._.._..•--------.....•••••••••........_----••---••-------_._._...__....•---------------•_...•-••---•--------•-•-••••-••-••. -••••-•--••-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of halth. d „ ~ a .._Signe . te• Application Approved By...................•--r------`-- .............. •---=.. - .... -- _ f Date Application-Disapproved for the following reasons:.___,_______________________.................................................................................... •----•-•-------------•-••---.._--•-••-••••••--••-••------•-•••••...---=--••••••,-••-•••••••••----..---•••-•...:------------- __...._..----•••-•----------••--•---•----•••••••-•--••••-•••-•-•......... Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. THIS IS TO CERTIFY, That the Individual/Se,,yag�,,,Djsposal $ m constructed ( or Repaired ( ) b `� a"-.........""� t �`� .- °i � ` t a fry ter__ ,._. Y 'Installer Y , has been installed in accordance with the provisions of Article XI of The State Sanitary Code as.described in the application for Disposal Works Construction Permit No----------____4 ................ dated_--___�_� -:-_--_,;--______________.. TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONAATISFACTORY. ti�f w' .-/•••__ Inspector _..-• �,.;.� DATE••_.._.' .. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE................ Permission is hereby granted = t ' .............. to Construct ( ) or Repair ( :.) an individual Sewage Disposal System y..;. .... ....................... ......................... ---- ... . _..._ ..._.. .. Street as shown on the a lica.tion for Dis oral Works Constl uction mit No. ��49�,PP P ated ••--- 4 ,y Board of Kcalth- DATE = °...+�..._,� ---- ----- ,r ��. FORM 1255 HOBBS & WARREN,. INC.. PU'F_lSHERS. - ''